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An aberrant right hepatic artery arising from the gastroduodenal artery: a pitfall encountered during pancreaticoduodenectomy

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Abstract

Purpose

Among the variations of the right hepatic artery (RHA), the identification of an aberrant RHA arising from the gastroduodenal artery (GDA) is vital for avoiding damage to the RHA during surgery, since ligation of the GDA is necessary during pancreaticoduodenectomy (PD). However, this variation is not frequently reported. The purpose of this study was to focus on an aberrant RHA arising from the GDA, which was not noted in the classifications reported by Michels and Hiatt.

Methods

A total of 574 patients undergoing a PD between Jan 2001 and Dec 2015 at a tertiary care hospital in Switzerland (n = 366) and between Jan 2009 and May 2015 at a hospital in Japan (n = 208) were included in the analysis. Of these, preoperative CT angiography or/and MRI angiography findings were available for 532 patients. We retrospectively analyzed the hepatic artery variations, patient demographics, and surgical outcomes.

Results

Among the 532 patients who received a PD, an RHA originating from the GDA was observed in 19 cases (3.5%). Eleven patients (2.1%) had both an aberrant RHA and an aberrant left hepatic artery (LHA) (Hiatt Type 4). Six patients (1.2%) had a replaced CHA arising from the SMA (Hiatt Type 5). We could, therefore, correctly identify the aberration in all cases.

Conclusions

We observed rarely reported but important aberrant RHA variations arising from the GDA. To prevent injury during PD in patients with this type of aberrant RHA, intensive preparations using CT and/or MRI imaging before surgery and intraoperative liver Doppler ultrasonography are considered to be essential.

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Authors and Affiliations

  1. Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan

    Takamune Yamaguchi, Kiyoshi Hasegawa, Yusuke Kazami, Takashi Kokudo, Kosuke Kobayashi, Nobuhisa Akamatsu, Junichi Kaneko, Junichi Arita, Yoshihiro Sakamoto & Norihiro Kokudo

  2. Department of Visceral Surgery, University Hospital of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland

    Takamune Yamaguchi, Marc-Olivier Sauvain, Stefano Passoni, Alessandra Cristaudi, Emmanuel Melloul, Emilie Uldry, Nicolas Demartines & Nermin Halkic

  3. National Center for Global Health and Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan

    Norihiro Kokudo

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  1. Takamune Yamaguchi
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Correspondence to Kiyoshi Hasegawa or Nermin Halkic.

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Yamaguchi, T., Hasegawa, K., Sauvain, MO. et al. An aberrant right hepatic artery arising from the gastroduodenal artery: a pitfall encountered during pancreaticoduodenectomy. Surg Today 51, 1577–1582 (2021). https://doi.org/10.1007/s00595-021-02242-4

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